The pandemic’s effect on discharge against medical advice from the emergency department



COVID-19, Discharge against medical advice, Emergency department, Pandemic


Background/Aim: Reasons for discharge against medical advice (DAMA) may vary according to countries' conditions and environmental or individual factors. Patients who choose to leave the hospital against the doctors’ recommendations are at risk of inadequate treatment and increased rehospitalization risk. The COVID-19 disease has come to the fore with a pandemic and the atmosphere of fear and panic it creates. We aimed to investigate the effect of fear of the pandemic on DAMA. Methods: This study was conducted in the emergency department (ED) of a tertiary hospital in Turkey. The characteristics of all patients who were discharged against medical advice and their reasons over six months at the beginning of the pandemic were examined prospectively. Results: A total of 263 patients left the ED on various excuses against medical advice between February 6-August 31, 2020 (DAMA rate: 2.4‰). The most common complaint of patients discharged against medical advice was abdominal pain (27%). The top 3 most common causes of DAMA were the fear of being infected by COVID-19 (36.5%), the thought of being neglected (12.2%), and the month of Ramadan (11.4%). Conclusion: The pandemic is an important reason for DAMA. Patients leave the hospital against medical advice with an avoidance-avoidance conflict during the COVID-19 pandemic. Defining dirty and clean areas within the emergency services with sharp boundaries and informing patients may prevent DAMA due to the fear of being infected with COVID-19. Physicians do not ignore the risk of progression to worse clinical outcomes in patients who discontinue treatment due to the pandemic.


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Research Article

How to Cite

Demir MC, Ağaçkıran İlter, Özdamar Y, Boğan M. The pandemic’s effect on discharge against medical advice from the emergency department. J Surg Med [Internet]. 2021 May 1 [cited 2024 Jul. 15];5(5):433-8. Available from: